Preventing falls in older people after discharge from hospital as a result of a fall

Exercise component: The intervention will consist of a baseline assessment (approximately 1 hour within 1-2 weeks of discharge from hospital) with a researcher to gather preliminary data for quality of life, falls risk and functional capacity., Following baseline assessment, the exercise physiologist will undertake data collection (in a session of approximately 1 hour duration within 2 weeks of the initial baseline assessment) for mobility, strength and balance, as per assessment tools outlined below. design a program dependent upon the stratification of frailty. For those deemed non-frail an exercise program will be designed, demonstrated and modified based on the Otago Exercise Programme . This programme consists of graduated lower limb strengthening and balance exercises that can be individually prescribed and modified according to the abilities of the individual. According to the Otago Exercise Programme protocol, the exercise physiologist will visit at one, two, four and eight weeks to ensure reduction of risk and enable tailoring of the program to participant needs. Participants will be provided with instruction on how to perform the exercises safely with the use of stable supports such as a table or assistance of a family member/carer. Participants will also be provided with a list of safety precautions, guidelines and diagrams of the exercises for their reference. Participants will be asked to undertake a 20-30 minute exercise program, three to five times per week for the duration of the intervention. The exercise physiologist will provide the participant with a log book to record their exercise activity and any comments they may wish to make about the effects of exercise (e.g. exercise difficulty, muscle soreness, barriers to exercise). A final assessment will be conducted at six months, undertaking the same measures as at baseline. For participants deemed frail, the intervention will consist of the provision of functional exercises that can be performed safely and independently (such as sit to stand) and a home safety check to ensure that mobility and transfers are deemed safe. Medication review component: A review of medications will be conducted by a pharmacist with Home Medicines Review accreditation. It is anticipated that this pharmacist will be linked with the hospital pharmacy outreach service and be engaged on a casual basis to conduct the reviews. The pharmacist will be in contact with the GP within 1-2 weeks of the participant being randomised to the intervention group. A list of current medications will be obtained from the GP and a review of medicines conducted in the person's home (approximately 1 hour). Recommendations will be followed up the GP through a letter. A Drug Burden Index will be calculated. Medications will be assessed at the final six month assessment as part of the FROP-Com assessment tool. Education component: Participants will be provided with education from the exercise physiologist at visits one, two, four and eight weeks drawing on a falls prevention booklet, which includes risk factors for falls, environmental modification to reduce falls risk and what to do after a fall. Approximately 15 minutes of each session is allocated to one to one discussion, according to the person's high falls risk factors initially, the person's interest area, gradually working through the entire booklet. The booklet is to be used as a reference for the person, with any questions generated to be asked at the next session.